Understanding Psychodynamic Therapy

Psychodynamic therapy aims to address unconscious thoughts, desires and impulses by bringing them up to the conscious mind of the individual to cope with the underlying issues and maladaptive behaviours as a result of unconscious thoughts. This approach lays its foundation in psychoanalytical theory given by Sigmund Freud. Although, it has evolved in its nature since the 19^th century with significant contributions of Carl Jung, Alfred Adler, Erik Erikson, Anna Freud and Melanie Klein. Some of its key concepts are:

1. Unconscious Mind

According to Freud, the unconscious mind contains repressed desires, sexual impulses and irrational beliefs, which influence one’s behaviour and train of thoughts. Thus, if these unconscious thoughts are brought to the conscious mind of the individual, via dream analysis or free association, it resolves the underlying issues or internal conflicts.

2. Free Association

This is a method, where the client is allowed to verbalize their thoughts without filtering or censorship no matter how trivial, irrelevant or embarrassing it may seem. By this approach, the unconscious material is brought to the surface, revealing hidden conflicts and desires. Moreover, this method helps bypass the conscious mind’s defences thereby giving access to the repressed memories. For example, a client may be describing his workplace scenario through free association, thereby revealing feelings of inadequacy linked to overly critical parenting styles in their childhood, thus explaining how past experiences shape our current perceptions. 

3. Dream Analysis

This approach is considered a royal road to the unconscious. The dreams provide a direct glimpse into the unconscious mind of an individual, where the repressed thoughts and desires are expressed symbolically. The individual describes their dreams in detail, and the therapist interprets the underlying message hidden behind them. For example, a client might dream about a shadow that follows them everywhere, a therapist might further interpret it as anxieties, fears or repressed emotions. By addressing the unconscious thoughts and fears, a client gains insights about their anxieties thereby making them work through the same in therapy.

4. Transference and Countertransference

Transference is a process where the client projects the feelings they have towards significant people in their lives onto the therapist. This method helps the therapist understand the individual’s family dynamics or interpersonal styles which aids in addressing and resolving internal conflicts. Whereas, countertransference is a process where the therapist projects their cognitions, attitudes and feelings towards the clients. This approach aids the client in understanding how relationships influence behaviour and emotional responses.

 5. Interpretation

This is the most crucial step of psychodynamic therapy where the therapist provides insights and explanations to the client about their behaviours, thoughts, dreams, fears, and relationship styles. This method enables clients to understand the deeper meaning behind their experiences, especially past childhood memories. For example, when a client explains how they feel entrapped in their workplace, the therapist offers an explanation where the client understands that it is a reflection of the experiences in childhood by their authoritative parents which exhibits a deeper root of entrapment.

6. Conflicts within the Id, Ego and Superego

It is referred to as the pleasure-seeking principle, which exhibits the drives and desires and strives for its gratification. The superego is the morality component that produces feelings of guilt or pride depending upon the individual conforming to the ethics, values, principles and morals of the society. The ego operates on the reality principle, which mediates between the demands of the Id and the moral values of the Superego. Internal conflicts arise as a result of interaction between Id, Ego and Superego which significantly influences the behavior and mental health of an individual. 

Defence mechanisms are processes by which the ego protects the conscious mind from the distress caused by internal conflicts. These mechanisms can be adaptive or maladaptive operating unconsciously. Some of them are:

• Repression: This mechanism blocks and prevents unacceptable thoughts, feelings, desires or impulses, although these repressed cognitions contribute towards influencing an individual’s behaviour. For example, someone who experienced a traumatic childhood event has no memory of it but feels inexplicably anxious in similar situations.
• Denial: This mechanism refuses to accept the reality or facts which prevents emotional pain. For example, a person diagnosed with a terminal illness insists, “The tests must be wrong, I feel perfectly healthy.”
• Projection: This mechanism leads to an individual attributing their thoughts to someone else. For example, a person who is angry with a colleague accuses the colleague of being hostile toward them.
• Displacement: This mechanism leads to an individual redirecting their emotions and anger towards less threatening stimuli. For example, after a heated argument with their boss, a person comes home and snaps at their partner for no apparent reason.
• Sublimation: This mechanism allows an individual to channel unacceptable impulses into socially acceptable behaviour. For example, a person with aggressive tendencies becomes a professional athlete or takes up boxing as a hobby.
• Rationalization: This mechanism justifies unacceptable behaviour or emotions with seemingly logical reasons, thereby avoiding the true explanation. For example, after being rejected for a promotion, an employee says, “I didn’t want that job anyway as it would have been too stressful.”
• Regression: This mechanism makes an individual behave or act according to an early developmental stage to cope with stress. For example, an adult, overwhelmed by stress, begins to throw tantrums or cuddle a stuffed animal for comfort.
• Reaction formation: This mechanism makes an individual behave oppositely to their unacceptable thoughts, impulses or desires. For example, a person who feels intense anger toward someone might act overly friendly and accommodating toward them.

History of Psychodynamic Therapy

Carl Jung made significant contributions to psychodynamic theory by expanding Freud’s ideas and introducing some key concepts that emphasized the role of collective unconscious and archetypes. His school of thought was referred to as analytical psychology.

According to him, there is a universal layer of the unconscious that is shared among all humans, housing archetypes and instincts inherited through evolution. Jung identified universal symbols and patterns of behaviour as archetypes that reside in the collective unconscious.

These archetypes shape human behaviour, emotions, and dreams. The Self represents the integration and wholeness of the psyche. The Shadow comprises the darker, hidden aspects of one’s personality. The Persona is the social mask that one wears to fit societal expectations. The Anima represents the feminine side in men and the Animus represents the masculine side in women. Instead of uncovering repressed conflicts to alleviate symptoms, Jung focused on helping individuals achieve individuation and balance between conscious and unconscious elements.

Alfred Adler diverged from Freud’s ideas particularly regarding the emphasis on sexuality as the primary driver of human behavior. In 1911, Adler began his school of thought referred to as individual psychology. This approach is teleological, which focuses on the purposes and goals of behaviour.

According to Adler, feelings of inferiority are fundamental to human experience which arise from real or perceived shortcomings and drive individuals to strive for superiority and success.

Moreover, he emphasized the significance of birth order, where the position of an individual in the family constellation (firstborn, middle child, last-born etc.) influences their behaviour and personality traits. This approach resolves conflicts by diving into the family dynamics and early recollections of the individual. Additionally, through constant encouragement from the therapist’s side and effective goal setting and action planning one alleviates their distress.

Erik Erikson was best known for his theory of psychosocial development, which expanded upon Freud’s psychosexual stages. Erikson believed that human development continues throughout life and is shaped by social and cultural influences as well as individual interactions with their environment instead of sex being the sole driver of human behaviour. There are eight stages of psychosocial development, each marked by a specific conflict that must be resolved to achieve healthy psychological development.

Anna Freud was the youngest daughter of Sigmund Freud, who significantly contributed to the development of psychoanalytic theory, particularly in the fields of child psychology and defence mechanisms.

She extended her father’s ideas, emphasizing the role of the ego and its mechanisms in development and adaptation. She was the pioneer who established play therapy as a means to understand children’s unconscious conflicts and anxieties.

Anna Freud introduced the concept of developmental lines, which describe the gradual transition from immature to mature behaviour in various areas of life for example, how a child moves from relying on caregivers to becoming emotionally independent or from egocentric behaviour (self-centred behaviour) to building companionship.

Melanie Klein shifted the focus of psychoanalysis from Freud’s emphasis on instincts and sexual drives to the infant’s relationships with primary caregivers, which she referred to as “objects” (not physical objects, but significant others) which is a symbolic representation that fulfils a psychological need. She believed the infant’s experiences with these caregivers shape their internal world and influence future relationships. This theory was called as object relations theory. 

Limitations of Psychodynamic Therapy

Psychodynamic therapy is time-consuming and expensive as it requires a long-term commitment with therapy sessions lasting over several months or years. It is less structured as compared to modern modalities like CBT (cognitive behavioural therapy), as the open-ended approach often lacks direction. Unconscious processes are difficult to quantify and measure thus it is difficult to measure the outcomes of an individual. The therapy often emphasizes uncovering past experiences and childhood dynamics, which may not resonate with clients who are more focused on immediate problems or practical solutions.

Thus, these individuals need action-oriented or solution-focused therapy which is efficient. Psychodynamic therapy is rooted in Western concepts of individuality and introspection, which may not align with the values or worldviews of some cultures that prioritize collective well-being over personal exploration. Insight and behavioural change in psychodynamic therapy often take time to develop and certain individuals might resist uncovering past recollections and traumatic childhood experiences which elicit stress and anxiety.